Provider Demographics
NPI:1619304862
Name:LEWIS, KURT JAN (LLMSW)
Entity Type:Individual
Prefix:MR
First Name:KURT
Middle Name:JAN
Last Name:LEWIS
Suffix:
Gender:M
Credentials:LLMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27777 INKSTER RD STE 100
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON HILLS
Mailing Address - State:MI
Mailing Address - Zip Code:48334-5312
Mailing Address - Country:US
Mailing Address - Phone:269-968-2811
Mailing Address - Fax:269-968-2651
Practice Address - Street 1:2777 INKSTER ROAD
Practice Address - Street 2:SUITE 100
Practice Address - City:FARMINGTON HILLS
Practice Address - State:MI
Practice Address - Zip Code:48334-3418
Practice Address - Country:US
Practice Address - Phone:855-772-8847
Practice Address - Fax:269-698-2651
Is Sole Proprietor?:No
Enumeration Date:2013-10-02
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010961671041C0700X, 106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical